0
Clinical Investigations: NONINVASIVE VENTILATION |

Amyotrophic Lateral Sclerosis*: Prolongation of Life by Noninvasive Respiratory Aids

John Robert Bach, MD, FCCP
Author and Funding Information

*From the Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey–the New Jersey Medical School, Newark, NJ.

Correspondence to: John R. Bach, MD, FCCP, Professor of Physical Medicine and Rehabilitation, Professor of Neurosciences, Department of Physical Medicine and Rehabilitation, University Hospital B-403, 150 Bergen St, Newark, NJ 07103; e-mail: bachjr@umdnj.edu



Chest. 2002;122(1):92-98. doi:10.1378/chest.122.1.92
Text Size: A A A
Published online

Study objective: To describe prolongation of survival in patients with amyotrophic lateral sclerosis (ALS) by continuous noninvasive intermittent positive-pressure ventilation (NPPV) and mechanically assisted coughing (MAC) using oximetry as feedback.

Setting: A retrospective review of ALS patients visiting one center from 1990 to 2000.

Design: Patients were trained in mouthpiece and nasal NPPV when symptomatic for hypoventilation, and trained in MAC with oximetry feedback when assisted peak cough flow (PCF) levels decreased to < 270 L/min. Survival was considered to be prolonged when full-time NPPV was required with limited ventilator-free breathing tolerance.

Results: Of 101 patients who met the criteria for access to NPPV and MAC, 15 have not yet used them, and 11 patients with severe bulbar muscle dysfunction died without ever successfully using them. Three patients used NPPV full-time, and oximetry and MAC episodically, but did not yet require ongoing NPPV. Eighteen used NPPV part-time for a mean (± SD) duration of 3.8 ± 4.1 months. Nineteen others underwent tracheotomy after 4.7 ± 4.5 months of receiving part-time NPPV. Sixteen patients used part-time NPPV for 17.5 ± 13.0 months (maximum, 25 months), then full-time NPPV for 14.1 ± 12.6 months (maximum, 40 months) before undergoing tracheotomy. Nineteen patients used part-time and full-time NPPV for 25.2 ± 19.8 months (maximum, 114 months) and 17.5 ± 13.3 months (maximum, 87 months), respectively, without undergoing tracheotomy. Ten of these NPPV users died once bulbar dysfunction became severe.

Conclusion: We conclude that up to continuous use of NPPV, along with MAC when needed, can permit prolonged survival and delay the need for tracheotomy for a significant minority of ALS patients by > 1 year.


Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543